Complicating Factors Associated with Mild Traumatic Brain Injury: Impact on Pain and Posttraumatic Stress Disorder Treatment

The nature of combat in Iraq and Afghanistan has resulted in high rates of comorbidity among chronic pain, posttraumatic stress disorder (PTSD), and mild traumatic brain injury (mTBI) in Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF). Although separate evidence-based psychological treatments have been developed for chronic pain and PTSD, far less is known about how to approach treatment when these conditions co-occur, and especially when they co-occur with mTBI. To provide the best care possible for OEF/OIF Veterans, clinicians need to have a clearer understanding of how to identify these conditions, ways in which these conditions may interact with one another, and ways in which existing evidence-based treatments can be modified to meet the needs of individuals with mTBI. The purpose of the present paper is to review the comorbidity of pain, PTSD, and mTBI in OEF/OIF Veterans, and provide recommendations to clinicians who provide care to Veterans with these conditions. First, we will begin with an overview of the presentation, symptomatology, and treatment of chronic pain and PTSD. The challenges associated with mTBI in OEF/OIF Veterans will be reported and data will be presented on the comorbidity among all three of these conditions in OEF/OIF Veterans. Second, we will present recommendations for providing psychological treatment for chronic pain and PTSD when comorbid with mTBI. Finally, the paper concludes with a discussion of the need for a multidisciplinary treatment approach, as well as a call for continued research to further refine existing treatments for these conditions.     

Nameless Desire: Alexithymia and the Anorexic Patient

In this article, the author attempts to provide a psychoanalytic understanding of the anorexic patient who is disconnected from her affective experience and is considered to be alexithymic. Through her restrictive food ritual, this type of patient may organize her internal states by repeatedly creating an illusion of what it is that she needs and desires. The author asserts that the task of the therapist working with the anorexic patient with alexithymia is to be aware of his own sensation-based reverie as lived within the intersubjective arena. This will enable the therapist to assist the patient in building an affective vocabulary to accurately identify, differentiate, and label the internal signals of her body. It is suggested that the subjective emotional experience of the patient will continue to be reorganized, expanded, and enriched as the therapist and patient mutually influence one another in this unique relational matrix. A clinical vignette is provided to illustrate intersubjective treatment interventions with a difficult-to-reach anorexic patient.     

THE EFFECTS OF DEFENDANT AND COMPLAINANT INTOXICATION ON MOCK JURORS' JUDGMENTS OF SEXUAL ASSAULT

The present study investigates the impact of participant gender, rape-myth beliefs, and alcohol intoxication on the part of either the defendant and/or alleged victim on mock jurors' decisions within the context of a sexual-assault trial. Participants ( N = 152) were exposed to a sexual-assault case in which the beverage consumption (alcohol, cola) on the part of both the defendant and complainant prior to the sexual intercourse was varied systematically. Results indicated that when the defendant had consumed alcohol, as opposed to cola, participants were more likely to view the case as one of assault, to perceive the defendant as less credible, and to find the defendant guilty. When the complainant had consumed alcohol, as opposed to cola, participants found the complainant's claim less credible and were less likely to view the defendant as guilty. In addition, participants' rape-myth acceptance, which was related to guilt, mediated the relation between gender of participant and guilt.     

Dual adaptation and adaptive generalization of the human vestibulo-ocular reflex

In two experiments, we examined the possibility that the human vestibulo-ocular reflex (VOR) is subject todual adaptation (the ability to adapt to a sensory rearrangement more rapidly and/or more completely after repeated experience with it) andadaptive generalization (the ability to adapt more readily to a novel sensory rearrangement as a result of prior dual adaptation training). In Experiment 1, the subjects actively turned the head during alternating exposure to a visual-vestibular rearrangement (target/head gain=0.5) and the normal situation (target/head gain=0.0). These conditions produced both adaptation and dual adaptation of the VOR but no evidence of adaptive generalization when tested with a target/head gain of 1.0. Experiment 2, in which exposure to the 0.5 gain entailed externally controlled (i.e., passive) whole body rotation, resulted in VOR adaptation but no dual adaptation. As in Experiment 1, no evidence of adaptive generalization was found.     

To Use or Not to Use: The Prenatal Genetic Technology/Worry Conundrum

We conducted an exploratory, qualitative study investigating the factors influencing the use of genetic counseling and prenatal genetic testing for two groups: pregnant women 35 years of age and over (AMA) at the time of delivery and pregnant women with an abnormal maternal serum triple screen (MSAFP3). The convenience sample consisted of 25 semistructured interviews of women/couples and 50 observations of genetic counseling sessions. Worry turned out to be the most important variable influencing decision making about prenatal genetic testing and was greater in the MSAFP3 group than in the AMA group. The women in the AMA group appeared to assign the risk of having a child with Down syndrome to their age category rather than to themselves individually, whereas, the risk perception for women with an abnormal MSAFP3 appeared to have shifted from a general population risk for pregnant women to an individual, personal risk. There was a general lack of understanding and also more misinformation about the MSAFP3 screen compared to amniocentesis. Women in both groups were torn between fear of an invasive test and worry about the health of their fetus for the rest of their pregnancy if they did not undergo amniocentesis.     

Findings on the relationship between Internet addiction and psychological symptoms in Brazilian adults

This study evaluated the prevalence of Internet addiction (IA) and its association with negative psychological symptoms in Brazilian adults. A network analysis was conducted to estimate specific variables and their expected influence on IA. In this cross-sectional study, 15,476 adults (M_age = 37.5, SD = 9.59) completed an open web-based survey. Three questionnaires were used: the Internet Addiction Test (IAT), Depression Anxiety and Stress Scale (DASS-21) and Satisfaction With Life Scale (SWLS). Based on IAT scores, participants were classified as No-Risk user (NRU), Low-Risk user (LRU) or High-Risk user (HRU). We observed that 4.8% of the participants were classified in the HRU group. In addition, their risk for severe symptoms of depression was 10 times higher and, for anxiety, seven times higher than that in the NRU group (p < .001). Time spent using smartphones was also significantly higher in the HRU group (M_hours = 5.1, p < .001). The main factors associated with IA were depression, gender and anxiety, but the variable “having children” was the most influential in the IA network. These findings suggest that psychiatric symptoms are the main factors associated with IA among the adult population.     

Anti-NMDA-Rezeptor-Enzephalitis

Die Anti-NMDA(N-Methyl-D-Aspartat)-Rezeptor-Enzephalitis ist eine seltene autoimmunologisch bedingte Erkrankung mit verschiedenen neuropsychiatrischen Symptomen, die durch den Nachweis von NMDA-Rezeptor-Antikörpern im Liquor diagnostiziert wird. Die gängigen Behandlungsprotokolle beinhalten ein Stufenschema der Immuntherapien; allerdings beruhen die therapeutischen Entscheidungen derzeit auf einem Grad-IV-Evidenzniveau. Wir berichten hier über zwei junge, unterschiedlich betroffene Patientinnen und beschreiben die Therapiestrategien inklusive der Kombination verschiedener Immuntherapien einschließlich Ocrelizumab und Überlegungen bezüglich Fertilitätserhalt.     

The relationship between childhood sexual abuse and sexual health practices of homeless adolescents

This study explored the gender differences in sexual self-concept, personal resources for sexual health, safe sex behaviors, and risky sexual behaviors among homeless adolescents with and without histories of sexual abuse. Data for this secondary analysis were collected in 2003 to 2004 in the first phase of a larger repeated-measures sexual health intervention study; 371 homeless youth between 16 and 23 years of age (M = 19.26, SD = 1.83) were recruited from a street outreach center. The majority (64.6%) of participants were males. Self-report instruments were completed at the outreach center via audio computer-assisted self-interview (A-CASI) format. It was found that female participants were better off than males on numerous measures of sexual health behaviors and attitudes. Sexually abused participants had significantly less future time perspective (p = .05), fewer sexual self-care behaviors (p = .04), and less social support than nonabused participants (p = .01) and almost significantly more sexual risk-taking (p = .08). However, no significant differences were found between abused and nonabused participants on sexual self-concept, self-efficacy or intention to use condoms, safe sex behaviors, AIDS knowledge, assertive communication, or self-efficacy to perform testicular/ breast self-exams. Overall, participants who did not report a history of sexual abuse had significantly more sexual health resources and engaged in fewer sex-risk behaviors than those who reported having been abused. These differences have notable implications for screening adolescents for a history of sexual abuse. Adolescents who report sexual abuse should receive risk counseling and be screened regularly for the development of sexual risk behaviors.     

Protecting Sexual Minority Youth from Research Risks: Conflicting Perspectives

This paper examines how a younger white female graduate student and an African American female undergraduate viewed the relationship between the graduate student and older African American working class women. This relationship was formed around a community garden project. The graduate student understood the relationship to be based on gender and class background similarities; the undergraduate viewed it based on race differences and unexamined white privilege. Both interpretations are challenged as unidimensional. Through this re-telling, questions are raised about why situating ourselves via our identities is not practiced more frequently. Possible explanations of this lack of attention to situativity include a Cartesian philosophy of science that separates objectivity and subjectivity, a general unawareness of privilege by those who have it, and a dominant scientific discourse that neglects the role of the researcher. This paper illustrates why reflexivity is crucial for the work of community psychology.     

The impact of competition on intrinsic motivation and creativity: considering gender, gender segregation and gender role orientation

The present research investigated whether competition influences children's artistic creativity and intrinsic motivation toward an art activity. Study 1 tested the hypothesis that boys' creativity would be enhanced by competition, while girls' creativity would be undermined. Fifty children (aged 6–10) made paper collages in one of two conditions; half competed for prizes and half did not. Results supported our hypotheses, and further showed that when children self-segregated by gender, the impact of competition was much more pronounced. Study 2 was designed to clarify the unexpected gender-segregation finding from Study 1. The Children's Sex Role Inventory [Boldizar, J.P. (1991). Assessing sex typing and androgyny in children: the Children's Sex Role Inventory. Developmental Psychology, 27, 505–515] was administered to 143 children (aged 6–11). One week later, these children made paper collages in one of four conditions; in addition to manipulating competition, assigned seating ensured that half of children were segregated by gender and half were not. Following the collage activity, an intrinsic and extrinsic motivation questionnaire was administered. Masculine children reported higher levels of intrinsic motivation when competing and when segregated by gender; they also reported higher levels of extrinsic motivation, especially when segregated by gender. These findings demonstrate that gender role is an important factor in determining children's responses to competition.